Patient Perceptions of Effectiveness in Treatments for Menière's Disease: a National Survey in Italy

Objective: The aim of this study was to investigate current treatment practices and self-reported effectiveness in Menière's disease. Materials and Methods: Members of two Italian Menière's disease support (n=170) with ≥6-month history of Menière's disease were administered an online survey about recent treatments. Vertigo episode count, work absenteeism, and limitations in family life, social life,work or travel, as included in the Social Life and Work Impact of Dizziness (SWID) Questionnaire before and after recent treatments were queried. Results: Twenty-four different treatments were reported for Menière's disease, with dietary modifications (55%), diuretics (47%), and betahistine (41%) being most common. The majority (71%) received multiple simultaneous treatments. Prior to the most recent treatments 78-89% of respondents indicated limitations in family or social life, work or traveling. After their most recent treatment, respondents reported improvements in mean vertigo episode counts (5.7±7.6 vs. 2.6 ±4.6, p<0.001), days off work per month (10.1 ±9.2 vs. 4.2 ±6.7, p<0.001), and proportions indicating limitations in any functional measure assessed (p<0.05). These findings were consistent regardless of treatment approach (all p<0.05). Intratympanic gentamicin provided the greatest reductions in vertigo count, functional limitations, and work absenteeism (all p<0.01) as well as the fewest respondents reporting post-treatment functional limitations (16-37%). Conclusions: Despite numerous treatment approaches targeting different proposed pathophysiology for Menière's disease in this cross-sectional survey, all treatments are reported as effective by patients. These findings support a prominent placebo effect in Menière's disease and highlight challenges in studying treatment outcomes; there is a critical need to better understand Menière's disease

Frequency Characteristics of Visually Induced Motion Sickness

This article was published in the journal, Human Factors [Sage Publications / © Human Factors and Ergonomics Society.]. The definitive version is available at: http://dx.doi.org/10.1177/0018720812469046Objective: The aim of this study was to explore the frequency response of visually induced motion sickness (VIMS) for oscillating linear motion in the foreand- aft axis. Background: Simulators, virtual environments, and commercially available video games that create an illusion of self-motion are often reported to induce the symptoms seen in response to true motion. Often this human response can be the limiting factor in the acceptability and usability of such systems. Whereas motion sickness in physically moving environments is known to peak at an oscillation frequency around 0.2 Hz, it has recently been suggested that VIMS peaks at around 0.06 Hz following the proposal that the summed response of the visual and vestibular selfmotion systems is maximized at this frequency. Methods: We exposed 24 participants to random dot optical flow patterns simulating oscillating foreand- aft motion within the frequency range of 0.025 to 1.6 Hz. Before and after each 20-min exposure, VIMS was assessed with the Simulator Sickness Questionnaire. Also, a standard motion sickness scale was used to rate symptoms at 1-min intervals during each trial. Results: VIMS peaked between 0.2 and 0.4 Hz with a reducing effect at lower and higher frequencies. Conclusion: The numerical prediction of the “crossover frequency” hypothesis, and the design guidance curve previously proposed, cannot be accepted when the symptoms are purely visually induced. Application: In conditions in which stationary observers are exposed to optical flow that simulates oscillating fore-and-aft motion, frequencies around 0.2 to 0.4 Hz should be avoided

Range expansion with mutation and selection: dynamical phase transition in a two-species Eden model

The colonization of unoccupied territory by invading species, known as range expansion, is a spatially heterogeneous non-equilibrium growth process. We introduce a two-species Eden growth model to analyze the interplay between uni-directional (irreversible) mutations and selection at the expanding front. While the evolutionary dynamics leads to coalescence of both wild-type and mutant clusters, the non-homogeneous advance of the colony results in a rough front. We show that roughening and domain dynamics are strongly coupled, resulting in qualitatively altered bulk and front properties. For beneficial mutations the front is quickly taken over by mutants and growth proceeds Eden-like. In contrast, if mutants grow slower than wild-types, there is an antagonism between selection pressure against mutants and growth by the merging of mutant domains with an ensuing absorbing state phase transition to an all-mutant front. We find that surface roughening has a marked effect on the critical properties of the absorbing state phase transition. While reference models, which keep the expanding front flat, exhibit directed percolation critical behavior, the exponents of the two-species Eden model strongly deviate from it. In turn, the mutation-selection process induces an increased surface roughness with exponents distinct from that of the classical Eden model

Dynamical simulation of current fluctuations in a dissipative two-state system

Current fluctuations in a dissipative two-state system have been studied using a novel quantum dynamics simulation method. After a transformation of the path integrals, the tunneling dynamics is computed by deterministic integration over the real-time paths under the influence of colored noise. The nature of the transition from coherent to incoherent dynamics at low temperatures is re-examined.Comment: 4 pages, 4 figures; to appear in Phys. Rev. Letter

Sequence randomness and polymer collapse transitions

Contrary to expectations based on Harris' criterion, chain disorder with frustration can modify the universality class of scaling at the theta transition of heteropolymers. This is shown for a model with random two-body potentials in 2D on the basis of exact enumeration and accurate Monte Carlo results. When frustration grows beyond a certain finite threshold, the temperature below which disorder becomes relevant coincides with the theta one and scaling exponents definitely start deviating from those valid for homopolymers.Comment: 4 pages, 4 eps figure

Driving-Induced Symmetry Breaking in the Spin-Boson System

A symmetric dissipative two-state system is asymptotically completely delocalized independent of the initial state. We show that driving-induced localization at long times can take place when both the bias and tunneling coupling energy are harmonically modulated. Dynamical symmetry breaking on average occurs when the driving frequencies are odd multiples of some reference frequency. This effect is universal, as it is independent of the dissipative mechanism. Possible candidates for an experimental observation are flux tunneling in the variable barrier rf SQUID and magnetization tunneling in magnetic molecular clusters.Comment: 4 pages, 4 figures, to be published in PR

Abnormal Visuo-vestibular Interactions in Vestibular Migraine: a Cross Sectional Study

Vestibular migraine is amongst the commonest causes of episodic vertigo. Chronically, patients with vestibular migraine develop abnormal responsiveness to both vestibular and visual stimuli characterised by heightened self-motion sensitivity and visually-induced dizziness. Yet, the neural mechanisms mediating such symptoms remain unknown. We postulate that such symptoms are attributable to impaired visuo-vestibular cortical interactions, which in-turn disrupts normal vestibular function. To assess this, we investigated whether prolonged, full-field visual motion exposure, which has previously been shown to modulate visual cortical excitability in both healthy individuals and avestibular patients, could disrupt vestibular ocular reflex (VOR) and vestibular-perceptual thresholds of self-motion during rotations. Our findings reveal that vestibular migraine patients exhibited abnormally elevated reflexive and perceptual vestibular thresholds at baseline. Following visual motion exposure, both reflex and perceptual thresholds were significantly further increased in vestibular migraine patients relative to healthy controls, migraineurs without vestibular symptoms and patients with episodic vertigo due to a peripheral inner-ear disorder. Our results provide support for the notion of altered visuo-vestibular cortical interactions in vestibular migraine, as evidenced by vestibular threshold elevation following visual motion exposure

Ensemble prediction for nowcasting with a convection-permitting model—I: description of the system and the impact of radar-derived surface precipitation rates

A key strategy to improve the skill of quantitative predictions of precipitation, as well as hazardous weather such as severe thunderstorms and flash floods is to exploit the use of observations of convective activity (e.g. from radar). In this paper, a convection-permitting ensemble prediction system (EPS) aimed at addressing the problems of forecasting localized weather events with relatively short predictability time scale and based on a 1.5 km grid-length version of the Met Office Unified Model is presented. Particular attention is given to the impact of using predicted observations of radar-derived precipitation intensity in the ensemble transform Kalman filter (ETKF) used within the EPS. Our initial results based on the use of a 24-member ensemble of forecasts for two summer case studies show that the convective-scale EPS produces fairly reliable forecasts of temperature, horizontal winds and relative humidity at 1 h lead time, as evident from the inspection of rank histograms. On the other hand, the rank histograms seem also to show that the EPS generates too much spread for forecasts of (i) surface pressure and (ii) surface precipitation intensity. These may indicate that for (i) the value of surface pressure observation error standard deviation used to generate surface pressure rank histograms is too large and for (ii) may be the result of non-Gaussian precipitation observation errors. However, further investigations are needed to better understand these findings. Finally, the inclusion of predicted observations of precipitation from radar in the 24-member EPS considered in this paper does not seem to improve the 1-h lead time forecast skill

Dynamics of a tunneling magnetic impurity: Kondo effect induced incoherence

We study how the formation of the Kondo compensation cloud influences the dynamical properties of a magnetic impurity that tunnels between two positions in a metal. The Kondo effect dynamically generates a strong tunneling impurity-conduction electron coupling, changes the temperature dependence of the tunneling rate, and may ultimately result in the destruction of the coherent motion of the particle at zero temperature. We find an interesting two-channel Kondo fixed point as well for a vanishing overlap between the electronic states that screen the magnetic impurity. We propose a number of systems where the predicted features could be observed.Comment: 4 pages, 3 figures, ReVTe

Association of socioeconomic position with maternal pregnancy and infant health outcomes in birth cohort studies from Brazil and the UK

Background: Socioeconomic inequalities in health outcomes are dynamic and vary over time. Differences between countries can provide useful insights into the causes of health inequalities. The study aims to compare the associations between two measures of socioeconomic position (SEP)-maternal education and family income-and maternal and infant health outcomes between ALSPAC and Pelotas cohorts. Methods: Birth cohort studies were started in Avon, UK, in 1991 (ALSPAC) and in the city of Pelotas, Brazil, in 1982, 1993 and 2004. Maternal outcomes included smoking during pregnancy, caesarean section and delivery not attended by a doctor. Infant outcomes were preterm birth, intra-uterine growth restriction (IUGR) and breast feeding for <3 months. The relative index of inequality was used for each measure of SEP so that results were comparable between cohorts. Results: An inverse association (higher prevalence among the poorest and less educated) was observed for almost all outcomes, with the exception of caesarean sections where a positive association was found. Stronger income-related inequalities for smoking and education-related inequalities for breast feeding were found in the ALSPAC study. However, greater inequalities in caesarean section and education-related inequalities in preterm birth were observed in the Pelotas cohorts. Conclusions: Mothers and infants have more adverse health outcomes if they are from poorer and less well-educated socioeconomic backgrounds in both Brazil and the UK. However, our findings demonstrate the dynamic nature of the association between SEP and health outcomes. Examining differential socioeconomic patterning of maternal and infant health outcomes might help understanding of mechanisms underlying such inequalities.A Matijasevich, CG Victora, DA Lawlor, J Golding, AMB Menezes, CL Araújo, AJD Barros, IS Santos, FC Barros, G Davey Smit